<wicket:extend>
    <form wicket:id="form">
        <table class="dataDetails">
            <tr class="title">
                <th colspan="2">
                    <wicket:message key="subscription.deregistration.title"></wicket:message>
                    <b wicket:id="title"></b>
                </th>
            </tr>
            <tr>
                <th><wicket:message key="subscription.deregistration.type"/></th>
                <td>
                    <span wicket:id="deregistrationType">
                        <input type="radio">CNF</input>
                    </span>
                </td>
            </tr>
            <tr wicket:id="privateIdTr">
                <th><wicket:message key="contextPanel.privateIdentity"/></th>
                <td><select wicket:id="privateIds"/></td>
            </tr>
            <tr wicket:id="publicIdsTr">
                <th><wicket:message key="contextPanel.publicIdentities"/></th>
                <td><select wicket:id="publicIds"/></td>
            </tr>
            <tr>
                <th><wicket:message key="subscription.deregistration.reasonCode"/></th>
                <td><select wicket:id="reasonCode"/></td>
            </tr>
            <tr>
                <th><wicket:message key="subscription.deregistration.reasonPhrase"/></th>
                <td>
                    <input wicket:id="reasonPhrase" type="text"/>
                </td>
            </tr>
            <tr>
                <th>&nbsp;</th>
                <td>
                    <input type="submit" wicket:id="submit" wicket:message="value:button.deregister" />
                    <input type="submit" wicket:id="cancel" wicket:message="value:button.cancel"/>
                </td>
            </tr>
        </table>
    </form>
</wicket:extend>